| NPI | 1548454465 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: OR 1245) |
| Additional Taxonomies | 103TF0000X Psychologist, Family (Licence: OR 1245) |
| 103TH0100X Psychologist, Health Service (Licence: OR 1245) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: OR 1245) | |
| 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: OR 1245) | |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: OR 1245) | |
| 103TC1900X Psychologist, Counseling (Licence: OR 1245) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: OR 1245) | |
| Enumeration Date | 2007-09-04 |
| Last Update Date | 2024-04-22 |